Prevalence and Associated Risk Factors of Sepsis among Neonates Admitted into Neonatal Intensive Care Units of Public Hospitals in Dhaka.

Zannatun Nyma,S M Mehedi Hasan,Naym Uddin Roby,Mahfuzur Rahman,Mohammad Ali,Farhana Khanam,Md Ehsanul Alam

doi:10.7759/cureus.7461

Abstract

Objective: To determine the prevalence and associated risk factors of sepsis among neonates admitted into neonatal intensive care units (NICU) of public hospitals in Dhaka.Methods: This was a cross-sectional study conducted among 173 neonates admitted into the NICUs of Dhaka Medical College Hospital (DMCH) and Dhaka Shishu (Children) Hospital from March 1, 2016 to September 30, 2016 at Dhaka, Bangladesh. On the basis of the presence of clinical signs and symptoms of sepsis, neonates were admitted into the NICUs. The weight of the baby was measured and blood culture, complete blood count (CBC), C-reactive protein (CRP) and urine R/M/E were done at the time of admission. The neonates, who had positive blood culture reports, were confirmed as having sepsis. After receiving informed written consent, maternal data were collected from the mother of the neonate and neonatal data were collected from NICUs.Results: The prevalence of sepsis among the neonates admitted into NICU of the concerned public hospitals in Dhaka was 69.35%. In the multiple logistic regression model, perinatal asphyxia (adjusted odds ratio (aOR) = 3.37, 95% confidence interval (CI) = 1.27-8.90), presence of infection at umbilical cord (aOR = 3.32, 95% CI = 1.40-7.85), history of bottle feeding of the neonates (aOR = 3.02, 95% CI = 1.11-8.25) and pre-existing maternal infection (aOR = 4.44, 95% CI = 1.92-10.26) were significantly (p-value < 0.05) associated with neonatal sepsis. The odds of developing sepsis among the neonates with ≤ 2.5 kg weight at admission was more than three times higher (aOR 3.82, 95% CI = 1.59-9.19) than neonates with admission weight > 2.5 kg.Conclusion: Like other South Asian countries, the prevalence of neonatal sepsis is alarming in Bangladesh. Further research should be conducted to measure the burden of infections in the entire neonatal period and observe the effects of biological risk factors on the early and late-onset neonatal sepsis.

Highlights

Over four million neonates die each year globally with the majority of the deaths occurring in low- and middle-income countries (LMICs) [1,2]
Fifty-eight percent of neonates were male and 79.77% had been suffering from perinatal asphyxia
Sixty-six percent of neonates represented the presence of infection at the umbilical cord

Summary

Introduction

Over four million neonates die each year globally with the majority of the deaths occurring in low- and middle-income countries (LMICs) [1,2]. The estimated neonatal mortality rate in LMICs is 20 per 1000 live births, compared to three per 1000 in high-income countries [2] These deaths have been categorically attributed to neonatal sepsis, meningitis, respiratory tract infections, diarrhoeal diseases, neonatal tetanus and prematurity which, in most cases, are preventable or treatable [3,4]. A systemic infection precipitating within the first 28 days after birth, encompasses bloodstream infection, meningitis, and pneumonia [7]. It currently is responsible for about 1.6 million annual deaths among neonates worldwide, 99% of which take place in developing countries [8,9]. South Asia and subSaharan African countries share the highest-burden of neonatal sepsis cases in the world; Bangladesh, being a developing South Asian country, is not an exception to this very trend [7,11]

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Discussion

Conclusion